title: Problem based review: the patient who has taken an overdose of long-acting insulin analogue.
abstract: Insulin overdose can cause harm due to hypoglycaemia, effects on electrolytes and acute hepatic injury. The established long-acting insulin analogue preparations (detemir and glargine) can present specific management problems because, in overdose, their effects are extremely prolonged, often lasting 48-96 hours. The primary treatment is continuous intravenous 10% or 20% glucose infusion with frequent capillary blood glucose monitoring. Surgical excision of the insulin injection site has been used successfully, even days after the overdose occurred. Once the effects of overdose have receded, diabetes treatment must be restarted with care, especially in patients with type 1 diabetes. Monitoring serum insulin concentration has been successfully used to predict when the effects of the overdose will cease.
authors.affiliation: King's College Hospital, Denmark Hill, London, SE5 9RS.
authors.forename: A E
authors.initials: AE
authors.lastname: Eldred
authors.forename: O G
authors.initials: OG
authors.lastname: Mustafa
authors.forename: K F
authors.initials: KF
authors.lastname: Hunt
authors.forename: B C
authors.initials: BC
authors.lastname: Whitelaw
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D062787:Drug Overdose; D004573:Electrolytes / Q000097:blood; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D007262:Infusions, Intravenous; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D013549:Sweetening Agents / Q000008:administration & dosage
chemical_list: D004573:Electrolytes; D049528:Insulin, Long-Acting; D013549:Sweetening Agents; D000069036:Insulin Glargine; D000069057:Insulin Detemir; C571886:insulin degludec; D005947:Glucose